Scientific Essay, 2017
Integrative Health Care
Aromatherapy as Complementary Alternative Measure (CAM) in Conductive Education
Integrative health care encompasses measures and activities that aim to achieve an increase of human health resources and the potential of maintaining and improving human health. The term describes the process of empowering individuals to increase their control over determinants of health and thus to positively impact their health. The focus is hereby not only on an individual’s behavior, knowledge, and abilities, but also on social, economic, and environmental circumstances. From a holistic perspective, health is defined as physical, psychological, and social wellbeing that is impacted by individual, social, and societal backgrounds. Hence, health is not so much a condition or a goal but rather a resource of daily life. According to the WHO Bangkok-Charta from 2005, it is the path to an improved quality of life. The interpretation of integrative encapsulates a meaningful integration of various forms of treatment in a therapeutic setting that emphasizes an interdisciplinary and comprehensive assessment of the patient, a scientific foundation, and an interdisciplinary approach: ‘Integrative medicine (IM) is the practice of medicine that emphasizes the importance of the relationship between physician and patient, focuses on the person as a whole, is based on evidence, and integrates all relevant therapeutic possibilities, health professions and disciplines in order to achieve optimal health and healing.’ 
Due to demographic developments, we experience an increase of the population segment with chronic conditions while at the same time less people are paying into the social security system. Chronically ill people not only suffer from their primary disease but also the associated side effects, as in the case of co- and multi-morbidities. A growing shortage of qualified personnel in the service sector and the obscurity of health care structures complicate the access to qualitatively optimized health care. A transformed social framework, reflected in the abolishment of the intergenerational contract and the rise of single households, signifies an increased need for associated processes around the topic of health in relation to self- and everyday-competence. For the chronically ill person, this creates expectations and stress due to political and social parameters and a paradigm change in medicine, where health is not defined as the absence of disease anymore. Navigating this complex system of societal norms, the goal of the health care of the future and the quality health care landscape is to achieve patient compliance through motivation and adherence to the treatment contract between the therapist and the patient. Hereby, the personalized health care next to the integrative health care becomes an increasingly important issue. It explicitly supplements the integrative health care in a humanistic sense. This is meant to emphasize the fact that people should not just be understood as molecular-biological variants, but more comprehensively as individuals in the broader context of their biological, psychological, mental, social, economic, cultural, and spiritual dimensions.
Along those lines, the focus is on the personal and individual components as a central element of a modern, patient-centered health care that is suited to offer the affected person support and direction towards collaboratively defined health care goals. Future-oriented health care models should be integrative and personalized in their methodology in order to coach individuals over a lifetime of health decisions assuring compliance as well as life quality in accordance with their individual resources.
The concept of conductive education is a Hungarian method for the treatment of individuals with chronic conditions of the central nervous system and congenital, infectious, or traumatic brain damage. The treatment approach is holistic, person-centered, and integrative. For this reason, it is exemplary for the success of human integrative health care. Conductive education hereby integrates aromatherapy with extracts of the medicinal plant sage into its holistic therapeutic setting.
Stress and quality of life are relevant factors in relation to the success of a therapy. Complementary and alternative methods of treatment (CAM) enjoy a growing demand among patients under treatment for acute or chronic conditions. Usually, CAMs are used to support the general wellbeing in positive ways. Individuals who do not use CAM have higher stress levels and a lower quality of life as compared to individuals who are using CAM. This infers that patients see CAM as beneficial in a treatment setting when it comes to an improvement of the general wellbeing.
Patients with chronic conditions often suffer from pain. Chronic pain (pain lasting longer than three months) has an impact on the biological, mental, and social component of a human being. It can limit social participation, reduce the quality of life, limit educational or professional prospects, and lead to physical comorbidity like depression, anxiety, and exhaustion. Chronic pain exposes the patient to permanent stress. M. Parkinson for example begins with unspecific symptoms like tiredness, physical weakness, a drop in productivity, constipation, depressive mood swings, a weakened sense of smell, sleep disorders, or painful muscle tensions that mostly occur unilaterally in the upper extremities. Moreover, pain in the neck-shoulder area, especially in the morning, is noteworthy. Multiple sclerosis is often accompanied with pain. Twenty percent of patients exhibit pain already during their first bout with the disease. Often, several kinds of pain are evident. Central pain after insult – ‘thalamic pain’- can occur after a stroke or after cerebral hemorrhage (cranio-cerebral trauma). Spasms are accompanied by strong motor-neuronal pain. Consequently, pain symptom progression is part of the course of a chronic condition. Pain symptoms are to be seen in conjunction with the stress that is caused by pain (endogenous) and the stress that is due to expectations by the environment that cannot be fulfilled (exogenous). This results in a mutual amplification of the pain-stress reality. For the affected person, the amplifying dynamics morph into an uncontrollable spiral of events. In the short- and medium-term this can lead to a distorted self-perception with psychological symptoms. This psycho-biological-social dynamic of pain affects the involvement in everyday life and education. Aromatherapy as a complementary measure in a therapeutic setting interferes at the physical, emotional, and somatic level. It is indicated for a lack of life quality, unsuccessful monotherapy, and an exhausted causal approach using chronic pain therapy. Indications are pain due to age, degeneration, trauma, and neuro-degenerative conditions. A precondition of aromatherapy as CAM is the mutual understanding of the disease among the therapists, as well as structured programs. Aromatherapy falls in the category of phytotherapies and can only be applied by doctors and remedial educators. According to a study by the Brüderkrankenhaus Trier, the successes are evident at the somatic and emotional level. Among patients treated for pain, 56% rated a pain reduction with aromatherapy as good.
Jane Buckle states that aromatherapy brings back ‘care into health care’. Aromatherapy as CAM classifies under regulative medicine because there is a clear correlation between product and effect. EEGs (electroencephalography) show areas of the brain with increased activity that can be linked with the olfactory experience of the aroma. Furthermore, physicochemical properties can mediate the impact on the human body.
Consequently, aromatherapy allows for a psychological sphere of influence via the olfactory sense and a physical one via the pharmacological effects of the ingredients. Moreover, it includes a subjective effect that is attributed to the patient. So, it is an individual’s expectation that is of importance, as much as the contextual attribution of smells according to the experiences that the user connects with them. Aroma characteristics are bound to the plant’s place of origin and are modified by environmental factors such as exposure to light, warmth, moisture, wind, and soil characteristics. Sage belongs to the labiate family. In aromatherapy, the labiate family is the plant group that is represented the most. As a renewable resource, it is a lasting and reliable oil resource. In general, sage exhibits strengthening and stimulating effects and is well tolerated. It should not be used during a pregnancy. Sage is processed as the whole plant. Aroma components are located close to the surface. Hence, sage can release its intense aroma when only touched or brushed. Sage belongs in the group of psychoactive and medicinal plants and is used for medical purposes. Sixty percent of the sage production finds its way into the pharmaceutical market, 35% is used in the food sector, and only 5% in cosmetics products. Imports from Hungary to Germany comprise 4.6 % of the plants. Hungary has a long-standing tradition in the cultivation of medicinal plants and grows approximately 70 different varieties on 40,000 hectares. As the market share for phytotherapy is growing, the exports are mainly standardized raw material. The chemotype of sage, i.e. the balance of its compounds, varies with its origin. Sage was given its name by the plant scientist Carl von Lineé based on its healing power (salvare, Lat. to heal). Aromatherapy uses Salvia officinalis, Salvia sclarea, and Salvia lavandufolia. Salvia officinalis and Salvia sclarea contain diterpene alcohol which has hormone-like effects on the human immune system. Moreover, it invigorates the interaction between hormones and nervous system and has an effect on emotion, cognition, and behavior. Additionally, it has a regulator function in the lymphatic system and in venous stasis. The compounds contained in Salvia officinalis, like thujone, camphor, lamiaceen, flavonoids, ursolic acid carnesol, and tannins, as a combination have disinfecting, antispasmodic, and analgesic properties. The skin-nurturing germacrene D is found in Salvia sclarea. Due to its interaction with cell membranes, it attenuates the transmission of pain and stimulates the secretion of neurotransmitters in the central and peripheral nervous system. Additionally, sclareol and linalool stimulate endorphin production which has an antidepressant and upbeat effect on the emotional state of an individual. It also has a calming and harmonizing effect on individuals with nervous anxiety states. It therefore has stress-relieving properties. Vitamins A and E revitalize the skin, linalyl acetate counters skin inflammation and eczema. The compound terpene has antibacterial properties. The essential oil from Salvia lavandufolia blocks the secretion of acetylcholinesterase in the brain. This has an effect on the nervous system which due to its high fat content responds especially well to essential oils. The relaxing effect on the striated musculature alleviates poor posture and peripheral paralysis, making those conditions corrigible. Its spasmolytic effect decreases chronic pain and leads to physical and mental relaxation. Aromatherapy with sage can be applied via the nose (fragrance lamp, inhalation), the skin (massage, bath, compress) or orally (infusion, food, extracts, drops, supplements). Since sage is rich in oil and therefore very well absorbed through the skin, baths and massages are especially recommended. The oil molecules are found in the patient’s blood and breath after just a few minutes.
Uses of aromatherapy in connection with water fall under hydrotherapy. This health-promoting treatment with water was already known in the old Greece. Sebastian Kneipp counted hydrotherapy among one of five pillars of health. Pastor Kneipp already promoted naturopathic treatments in a complimentary canon consisting of hydrotherapy, phytotherapy, exercise therapy, nutrition, and regulative therapy of the psyche. It should be highlighted that, like conductive education, complementary measures are employed to reach a health goal. At the center are hereby the holistic support of motor function, psyche, and cognition. In hydrotherapy, water is used on the body in its various physical states and temperatures for therapeutic purposes. The different reactions that water elicits in the human body are therapeutic. The addition of aromas can amplify this health-promoting effect. The therapeutic use of aromas can include oils and whole medicinal plants that had been wrapped in fabric or nylon. Different water temperatures are credited with different effects. Conductive education uses a warming sage bath, whereby sage in nylon netting is added to the water. The advantage of this method is that sage can breach the skin barrier without a carrier substance which allows a higher efficiency. The heat stimulation of the water is ideally complemented with the effects that sage has on the body of the chronically ill patient. The duration of the warm bath should be between 10 and 20 minutes. The temperature should be 36-37 degrees Celsius. The heat stimulation of the water increases the heart rate and body temperature. This increases circulation and metabolism and ensures a better response to chronic inflammation processes. Additionally, the warmth is mentally relaxing and soothing, which is ideal to curb stress-related symptoms. Water-related buoyancy of the body relieves the entire musculature. In combination with the stress-relieving, invigorating, antispasmodic, antiseptic, and analgesic effects of sage, a sage bath is the ideal pre-conditioning in exercise therapy.
The origin of aroma massage goes back to 1870. This form of treatment was created by physiotherapists drawing from their knowledge about the effects of the oils and their great resorption ability across the skin.
Massages are likely the most ancient therapy form in the history of human health care. They originate from a social form of interpersonal exchange through touch. Given that a pleasant touch is one of the first positive stimuli that encourage an individual to relate with the environment, it is a form of communication defining the human being.
Etymologically, the word ‘massage’ finds its origin in the Arabic language where ‘massa’ signifies ‘touch’. The healing power of touch in its physiological and psychological effects is part of the common cultural heritage of humanity. Over millennia, massage techniques have relied on tradition to evolve, ranging from Ayurveda healing arts from India, acupressure techniques from Japan and China, to Greek-Roman massage having influenced our tradition in Europe. The antique era of Europe featured an elaborate spa system that dated back to the time of gladiators. Cura (Lat. for care) includes baths in connection with massages. This is confirmed by numerous archeological finds from the Roman era. The goal of ‘cura’ was the preventative aspect of health and health care with a focus on maintaining physical performance and mental wellbeing. In this respect, baths and massages using medicinal herbs and oils as a therapy-supportive measure of conductive education are based in culture-intrinsic empirical science. Sainte Hildegard von Bingen (1098-1179) researched and developed the holistic naturopathy and elevated aromas to a prominent role in health therapy. The physician and pharmacist Samuel Heinemann for the first time puts homeopathy into the realm of science with his book ‘Organon der Heilkräuter’. Sebastian Kneipp and his teachings had a significant impact on the importance of aroma massage. Subsequently, in the 1970ies Shirley Price further developed aroma therapeutic applications. With the establishment of the profession of ‘physiotherapist’, aroma massage as complementary alternative method in medicine (CAM) finally was possible. Aroma massage combines the classical effects of massage, like muscular and mental relaxation, destressing, with the effects of aromatherapy. The essential sage oil is highly concentrated and cannot be applied to the skin in its pure form. Therefore, in aroma massage fats are used as carrier substances. The effectiveness of the massage is dependent on room temperature, the positioning of the patient, the nature of the carrier substance, and the regularity of the application. These factors impact the passage of the oil through the skin. The skin reacts to the massage stimulus by dilating blood vessels which supports circulation. Increased activity of perspiratory and sebaceous glands has a cleansing effect. The lymphatic system is drained and declogged as are the supplying blood vessels. Warmth promotes the maintenance of muscle cells, stimulating and increasing cell metabolism. Massage reduces muscle tone while increasing elasticity and contractile abilities.
The antispasmodic, analgesic activity of sage supports these processes. Due to the stimulation of circulation and vessel dilation, the organism can absorb the compounds of the oil better. Alleviating tension and pain through sage can also have a beneficial effect on the joints. The massage by itself elicits an increased synthesis of internal antibodies. The immune-modulatory, antiseptic and antiviral activity of sage therefore interacts ideally with processes that are triggered for the purpose of immune defense. Sage contains sesquiterpenes that have relaxing and balancing effects complementing the psychiatric effect of aroma massage. Stress can have an impact on an individual’s immune parameters, resulting in its deterioration and side effects like an increased vulnerability to physical or mental disease. Hence, factors of a chronic pain and stress overload correspond with the individual’s robustness of the immune system and mental condition. Sage used in aroma massage focuses on this interaction between nervous, immune, and hormone systems. Through its immune-strengthening compounds, sage balances central nervous processes. Stress is reduced and the psyche finds balance and wellbeing. These findings underscore research in psychoneuroimmunology investigating the holistic approach in the context of external and internal factors, i.e. stressors, and the mental and physical wellbeing of humans. An important aspect in achieving effects is a trusting relationship between patient and therapist as well as an emphatic attitude by the massage therapist with regard to the situational context that the individual under treatment is in. The transdisciplinary approach of conductive education for aromatherapy with massage as CAM is hereby of significance.
Conductive education focuses on the sensitization and the development of neuronal reflex pathways in handicapped individuals in order to achieve mobility and hence the participation in everyday life and education activities. Similar like the conditioning of classifying aromatic substances is based on visual or emotional engrams, motor exercises of conductive education train the stimulus-response-behavior. In this regard, interwoven learning is compatible with the modes of action in aromatherapy. Hence, the therapeutic template comes to agreement between preparing for therapy via aromatherapy and the educational-therapeutic measure. The significance of aromatherapy for conductive education derives from the interaction of motor reflexes and aromas impacting the psycho-social development.
The regular motor development in humans relies on the harmony of body and soul, results in social participation and the so-called social wellbeing. ‘The respiratory and digestive systems and a functioning blood circulation enable a healthy bone growth with a normally aligned structure. Movements and activities guarantee survival, ensure social interaction, eating in company, flight from danger, shelter and care for offspring. Movements do not occur in a vacuum. We move because we have intentions and goals.’ For the completion of an action, muscle tone is required. Muscle tone is the condition of muscle under contraction, achieved with the alternate contraction of different muscles. A muscle tone with regular function is required for regular reflexes. A reflex is an involuntary, stereotypical response of the nervous system to a stimulus. The vital functions of moto-neuronal pathways turn reflexes into operational actions allowing humans to acquire abilities. A disruption of these functions results in spasms, athetosis, and/or hypotension. The effects of these dysfunctions impact human motor function, language, and cognition which translates to a hampered access to everyday life and education opportunities and social participation. For example, an impaired hand function with pronated, inflected wrist joints can lead to persistent pain and social isolation because an impaired grip can limit an individual’s ability to play and work. This can lead to psychological and emotional stress, since expectation and the desire to succeed are not satisfied. A persistent motor reflex hampers participation because of suddenly occurring sensory or vestibular stimuli. An anxious attitude hereby increases the risk of triggering the reflex and consequently the danger of falling. The symptoms of a spasm include an increased muscle tone and stretching resistance. For a handicapped person, this can lead to a deceleration of movement patterns, improved reflexes and/or pathological polysynaptic reflexes. The clinical picture of a spasm includes pain. A spasm can get worse with psychological factors like fear, happiness, anger, or depression. A spasm can only lead to decreased intelligence when a lack of oxygen or an infection caused brain damage. Therefore, a gap in mental abilities and physical skills can contribute to a high pressure to perform.
Muscle hypotension and athetosis are characterized by weak muscle tension, a delayed development, and impaired coordination. With athetosis and hypotension, motion sequences and hence the display of coordinated motion patterns are strongly dependent on the person’s inner harmony. Stable emotions and psyche become critical factors for the success of a therapeutic measure. ‘When they are highly motivated, they can achieve great things; but when they become aware of their impairment or when they are insecure, the jerky movements act up. Social acceptance or rejection play a big role in their motor behavior and life style.’
All manifestations of disorders of the central nervous system show a strong dependency on external factors that influence the psycho-emotional situation of the patient. Consequently, decreasing stressors and establishing balance and harmony for the patient with the respective environment is important for the success of the treatment. In this respect, aromatherapy as interventional measure is significant in two ways. The integration of aromas into action schemas adds sensory experiences to the regulatory circuit of conductive education. The external stimuli of aromas elicit internal responses. In a therapeutic setting, they lead to psychological and motor reactions that in positive ways prepare for the education module. This procedure is critical for the sensorimotor development and for all learning processes. The integration process allows the patient to connect the perception of a fragrance with a feeling. The interpretation of the aroma enables the affected person to learn ensuing physical and mental responses and to integrate them into the conductive education that follows. This leads to a closed loop stimulus-response between sensory and motor system which can have a positive effect on plan of action, behavior, and learning process. For this reason, a targeted sensory input in conductive education via sage aroma as CAM makes sense.
Conductive education employs preparatory baths with sage leaves and subsequent muscle massages with sage-cream. Due to its properties, sage has a beneficial effect on the symptoms of spasms, athetosis, and hypotension. First, the antispasmodic and analgesic properties of the sage bath affect the psychological and physical condition of the individual. Spasms can be relaxed which brings relief. Euphorigenic substances contained in sage modify the person’s intrinsic motivation and decrease environmental stressors as well as stressors due to the own expectation. The antidepressant properties of sage impart elements that are calming and decrease anxiety and hence engage at the patient’s motivational level with regard to conductive education. Due to the fact that athetosis is characterized by emotions being reflected in the movement pattern, an inner balance contributes to the coordination of motion sequences in the educational process and thus learning. The supporting role of sage for the nervous system can have an effect on the functional improvement of the weakened musculature with hypotension. The antiseptic substances contained in sage positively influence the healing process of bedsores after spasms. The massage following the bath reinforces the effect of the bath and contributes to an improvement of life quality as a result of resolving blockades at the psychological and motor levels. The fragrance of sage interlinks with the significance of its effect. This leads the treated person to generate a mental engram that results in a reciprocal enhancement of positive learning contents if used repeatedly. In summary, it can be assumed that the integrative aromatherapy creates a regulated circuit between sensory activity and motor function that motivationally impacts the patient’s plan of action und thus positively interferes with their conceptual and cognitive learning processes. The integrative aromatherapy treatment aims to support the planning and organization of adaptive behavior through targeted sensory input and integration of sensory perceptions.
Aromatherapy is being used in conductive education for more than 30 years. The therapeutic learning approach of conductive education aims at the patient’s personality development. In order to make participation and decision making in the treatment process possible, a relationship of trust with the patient and stress reduction are important aspects. Patient coaching allows the patient to play an active role in his or her treatment and furthers its success. Through patient coaching, severely sick and impaired individuals garner support to recognize and employ their own resources to overcome the disease. Integrative methods in patient coaching of the modern, individualized practice find paths to and with the patient. The knowledge about reciprocal conditions of mental processes and body-regulating mechanisms demands an integrative approach in the care of chronically ill individuals. Integrative methods serve to tap into unused or hidden potential with health-related behavior. Aromatherapy and conductive education complement each other in their objectives since the activation of the individual powers of self-help and self-management are prominent with both. Aromatherapy with sage can increase the patient’s compliance with conductive education and consequently lead to a better adherence to the therapy course and defined health objectives.
Patient coaching focuses on the mobilization of the individual powers of self-help and self-management. In light of the mounting need of care for chronically ill and impaired individuals and the associated financial burdens, this approach becomes increasingly important. Patient coaching originates from the discipline of health communication. The premise is that adherence and patient compliance can be improved through complex and individualized accompanying measures. For this reason, an interdisciplinary patient care constitutes a quality characteristic in health coaching. The integration of aromatherapy into the treatment path of conductive education targets a patient’s psychological and physical aspects and enables increased cooperation between therapist and patient through stressor reduction. This creates optimal conditions to work resource-oriented and patient-centered. Aromatherapy as CAM in conductive education supports the generation of a preference structure that is in harmony with internal and external parameters. It taps into the patient’s resources and is part of the person-centered and multi-professional work, part of patient coaching.
Aromatherapy as complementary alternative measure in the conductive education taps into patient resources. The effect of a CAM can positively support a patient’s health coaching. Its holistic approach complements the didactics of the conductive treatment concept. From a pedagogical standpoint, the progressive relaxation method hones the patients’ self-management abilities. Aromatherapy reduces environmental stressors and relaxes the human psyche while refocusing on positive self-perception. Therefore, it has a supportive role with regard to attitude and self-concept of the individual within the setting of conductive education. The mobilizing and analgesic effect of sage supports gaining ortho-function. Thus, aromatherapy with sage contributes to the successful integrative treatment through empowerment. This puts emphasis on patient coaching which adds an important component to the success of the patient’s participatory decision-making. A person’s participation in the design of his or her therapy is important for the adherence to the treatment plan and for self-management. Aromatherapy in conductive education hence can contribute to therapy success and the improvement of life quality aspects for patients.
The ability for self-help and consequently the empowerment for active participation in everyday life is central. Hence, the concept of conductive education corresponds to a holistic/integrative approach to elicit psychological, physical, and social wellbeing through CAMs in the integrative care. Emotional, physio-social, and cognitive resources are tapped in aromatherapy. They can trigger thoughts, feelings, and actions that are accessed as so-called ‘coping patterns’.
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 Bundeszentrale für gesundheitliche Aufklärung (Ed.) Leitbegriffe der Gesundheitsförderung und Prävention. New edition. Verlag für Gesundheitsförderung, Werbach-Gamburg 2011
 Consortium of Academic Health Centers for Integrative Medicine 2004, www.imconsortium.org, translated by E. G. Hahn.
 Dörner G., Hüllemann K.D., Tembrock G., Wessel K.F., Zänker K.S. (Ed.) Menschenbilder in der Medizin, Medizin in den Menschenbildern. Berliner Studien zur Wissenschaftsphilosophie & Humanontogenetik, Volume 16, Kleine Verlag, Bielefeld, 1999
 Hári, M.et al. (1992), p. 9 ff: Das Petö-System. Prinzipien und Praxis der Konduktiven Erziehung. Budapest.
 Fink, A. (1998), p. 31: Praxis der Konduktiven Förderung nach Petö. Ernst Reinhardt Verlag.
 Buber, M. (1965): Das Dialogische Prinzip. Heidelberg.
 Spitzner, M. (2008) p. 46: Selbstbestimmen. Gehirnforschung und die Frage Was sollen wir tun? Spektrum Akademischer Verlag. Heidelberg.
 Huang L., Capdevila L. Aromatherapy Improves Work Performance Through Balancing the Autonomic Nervous System; J. Altern. Complement. Med. 2017; 23(3): 214-221.
 Statistisches Bundesamt. Neue Bevölkerungsvorausberechnung für Deutschland bis 2060. Press release, published 28.04.2015 – 153/15.
 Harms F., et al. (2009) Informationsbedürfnis von Krebspatienten. MVF. 2009; 4: 32-36.
 Singh D. (2008) „Wie lassen sich Disease-Management-Programme unter Einbeziehung sämtlicher Versorgungsumgebungen und- Dienstleister beeinflussen?“ ; Gesundheitssysteme und Politikanalyse. Kopenhagen.
 Statistisches Bundesamt. 7,6 Millionen schwerbehinderte Menschen leben in Deutschland. Press release, published 24.10.2016 – 381/16.
 Yang H.J., Kim K.Y., et al. Effects of Salvia Sclarea on chronic immobilization stress induced endothetical dysfunction in rats; BMC Complement. Altern. Med. 2014; 14: 396.
 Konduktorenverband, Bundesverband der Konduktoren e.V.10.09.2012, www.konduktorenverband.de/upload_files/eca_assoc.
 Sog. Sechster Kondratieff-Zyklus, see Nefiodow 2006.
 Bandura A. Health Promotion by Social Cognitive Means, in: Health Education and Behaviour. 2004; 31(2): 143-164.
 Mayer K.C. Frühe Erfahrungen prägen Stresstoleranz. Pharmazeutische Zeitung online. 2007; 25. www.pharmazeutische-zeitung.de/index.php?id=3237
 See: Heinrichs, N. et al. (2008) Prävention bei Paaren und Familie, Hogrefe.
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